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M Jomin

Publications and source records attributed to M Jomin.

At least 19 recordsLinked to original sources
PubMed1993

[Natural history and spontaneous prognosis of cerebral arteriovenous malformations].

Eight large series of patients presenting with untreated cerebral arterio-venous malformations (A.V.M.) were reviewed. Data were gathered on 1134 patients who were followed for 20 years or more. The risk of rupture and the rate of other complications were estimated, in relation with other factors like age of patient, size of A.V.M., or hemodynamic stresses. The prevalence of A.V.M. at autopsy is 14 per 10,000 population. Fifty percent of A.V.M.s remain asymptomatic during the whole patient's life. The risk of hemorrhage from rupture of an A.V.M. is 2% per year and per patient. Hemorrhage is more frequent from small-sized A.V.M.s, mostly under certain hemodynamic factors. The risk of hemorrhage is also higher in children between 5 and 10 years of age, and in women to the end of pregnancy. The incidence of seizures and neurological impairment is approximately 1% per year and per patient, and these symptoms mostly occur in elder patients with large A.V.M.s. If the A.V.M. has not been revealed by hemorrhage, the risk of rupture is 1% per year and per patient. The incidence of complications from fortuitously diagnosed A.V.M.s seems very low, and even nil in some series. The risks of therapeutic procedures could not be determined, but in some A.V.M.s, the association of different therapeutic means seems mor advisable than isolated therapy. The analysis of natural history of A.V.M.s is desirable to provide a better information to the patient, and to define the limits of therapeutic indications.

Age Factors↗
PubMed1993

[Cerebral tumors and pregnancy. Apropos of 8 cases].

Pregnancy is an aggravating factor for brain tumours on which it acts by three mechanism: acceleration of tumour growth, increase of peritumoral oedema and the immunotolerance to foreign tissue antigens that is proper to pregnancy. Histologically, the brain tumour most frequently encountered is glioma, usually revealed during the third trimester. Brain tumours is pregnant women have no special clinical features, and their diagnosis rests on computerized tomography or nuclear magnetic resonance completed, if required, by stereotactic biopsy. Following a review of the literature, the authors present an updated description of the neurological and obstetrical actions to be taken, illustrated by a report of eight personal cases. The indications for surgery depend on the site and histological nature of the tumour. As regards obstetrical measures, induced therapeutic abortion and caesarean section, no longer routinely performed, are now being replaced by vaginal delivery with systematic instrumental extraction. In both mother and foetus the prognosis has improved over the last ten year, but it remains very sombre.

Adult↗
PubMed1992

[Cerebral aneurysms and pregnancy: 4 cases].

Haemorrhagic cerebral accidents are the commonest neurosurgical diagnoses made in pregnancy. The state of pregnancy makes it more likely that an arterial or an arteriovenous aneurysm will rupture and this is the principal cause of most haemorrhages. They occur more often in primiparae in the third trimester of pregnancy. The clinical picture is classical. The conformation of the diagnosis is made by scanning and angiography. The main differential diagnosis is eclampsia. Neurosurgical treatment should be carried out immediately whenever possible in order to avoid the two great risks that follow, namely recurrence of haemorrhage and secondly ischaemia. As far as the obstetric side is concerned, Caesarean section would only be indicated if: the clinical state of the mother is severe with coma and brain stem damage when the child is viable, if there is symptomatic vascular malformation diagnosed at term, if there is haemorrhagic arteriovenous malformation which is highly liable to occur and cannot be operated on without risks for the child if viable, if, finally, the interval between the surgical treatment of the condition and labour is less than 8 days. In all other cases a vaginal delivery is preferable under epidural anaesthetic which should be given if medical induction is carried out, and where instrumental delivery is being carried out systematically, unless radical treatment is being performed. The prognosis which is, in spite of all steps that may be taken, poor, depends on the initial neurosurgical stage and the nature of the causes of lesion and the possibilities of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Hydrocephalus with cerebrospinal fluid shunts and pregnancy: 2 cases].

During pregnancy 50% of all cases with a ventriculo-peritoneal shunt malfunction. This is because of anatomo-physiological changes associated with the pregnant state, and shows itself as a rise in intracranial tension. There were no acute neurological complications at term; with the malfunction of the shunt distally, vaginal delivery is preferable. It is not necessary routinely to carry out instrumental delivery.

Adolescent↗
PubMed1991

[Importance of the study of the cytology and proteins of the spinal fluid in lumbago].

In the cerebrospinal fluid (C.S.F.) of hundred patients suffering from lumbago we have studied the existence of cytobiochemical and cytoradiological correlations in order to confirm the demonstration of cytologic and biochemical signs of organicisty or seriousness of this frequent pathology. We have realized cytorachia, that is to say differential cells counts and formulas on C.S.F. samples after cytocentrifugation and staining associated with biochemical determinations. Cytologically 96% of C.S.F. samples had normal count but 67% of them had a disturbed formula often associated with hyperproteinorachia. We have found lymphocytes and histiomonocytes the normal cells of C.S.F. but also neutrophilic, eosinophilic and basophilic polymorphonuclears and above all leptomeningeal cells. A disturbed cytorachia is often related with a pathological radiological picture (68% of cases). A cytologic anomaly with hyperproteinorachia in the same C.S.F. sample seems to be a sign of seriousness and to reveal a resistance to medical treatment. A technical presentation of cytorachia and an attempt of physiopathological explanation of observed cytologic abnormalities are proposed.

Back Pain↗
PubMed1990

Management of focal intracranial infections: is medical treatment better than surgery?

Three groups of patients with single hemispheric brain abscesses or subdural empyemas, from 1 to 5 cm large, with similar initial prognosis, have been treated either by medical treatment alone (20), aspiration (21), or excision (15). Differences in survival were not found, but medical treatment alone was better for long term sequelae. Surgical procedures (either aspiration or excision) were better for both isolation of the organism and the hospital stay before discharge. In spite of good results, it is unwise to conclude too strongly in favour of no surgical treatment as this study was not randomised.

Adult↗
PubMed1990

[Management of meningeal hemorrhage for angiographic evaluation].

Perfect immobilization of the patient is mandatory when performing cerebral angiography. It allows good analysis and diagnosis of arterial or arterio-venous malformations. Neuroleptanalgesia or general anesthesia are currently used. Most common complications are due, either to induced arterial hypertension or to arterial catheterism (vasospasm or embolism). Early diagnosis and adequate treatment are necessary.

Anesthesia↗
PubMed1990

[Natural history and current surgical prognosis of intracranial arterial aneurysms].

The abrupt flow of blood in the meninges or in the brain after fissure or rupture of an arterial aneurysm still remains a medico-surgical emergency which includes the mobilisation of important technical and financial means which justifies itself by the reduction of the occurrence of a more severe accident and to give the patient its best chances. The cure of a cerebral aneurysm and its intracranial consequences must not be dissociated from its clinical context. Surgical indication must take into account the cause of the vascular lesion, the background on which it has evoked, its natural outcome which is characterised by rebleeding and vasospasm. Surgical cure of intracranial aneurysm is one of the great achievement of modern surgery. A better understanding of the malformation, the improvement of neuro-anesthesia and intensive care, and the use of pre-operatoire adjuvants have considerably improved the surgical results over the years. At the moment, alternative treatment start to emerge such as selective vascular catheterism with ejectable balloon which become more feasible and seductive.

Catheterization↗
PubMed1990

[Clinical course after surgery of aneurysms of the anterior communicating artery].

The evolution and correlations between initial state and outcome (one year) are analysed in 81 patients with anterior cerebral artery aneurysm. The age and initial evaluations are seldomly correlated with late evaluations, Jennett and Holbook scales, frontal syndrome, amnesia. The evaluations at one month are very significantly correlated to the late evaluations.

Adolescent↗
PubMed1990

[Rhythmical myoclonus and tremor at rest disclosing mesencephalic metastasis].

We report a case in which rhythmical myoclonus and tremor at rest revealed a thalamo-subthalamic metastasis from a bronchial carcinoma. Tremor of the upper limbs and face (4 Hz) disappeared with sustained posture and action. A cogwheel phenomenon, hypotonia and disorders of automatic and voluntary movements were also present. Surface electromyographic recordings showed a rhythmical, synchronous activity of the biceps brachialis and triceps muscles at rest. Pathology disclosed lesions of the red nucleus and neighbouring area and severe compression of the substantia nigra which were likely to be the cause of the signs and symptoms.

Adenocarcinoma↗
PubMed1990

[Cellular kinetics of cerebral glioma: study of the proliferative activity using monoclonal antibody Ki 67. Apropos of 60 cases].

The monoclonal antibody Ki 67 is able to detect a nuclear antigen expressed by proliferating cells during the cellular cycle (phase G1, G2, S and M). It is used as a marker of the proliferative activity of 60 cerebral gliomas including 41 biopsied under stereotaxic conditions. The immunocytochemical study performed with the peroxidase antiperoxidase technique on crushed and smeared fresh tumors, permit to define a nuclear marking index for each tumor. The index Ki 67 is correlated with the degree of tumor malignancy. The maximum values are found in astrocytomas IV (20%) and malignant ependymomas (18%), with a mean index at 11% in the 25 high-grade gliomas and 1.7% in low-grade gliomas. The minimum values are observed in pilocytic astrocytomas and low-grade oligodendrogliomas. Marked variations of the index Ki 67 are found in homogeneous tumor classes regrouping tumors of identical nature and grade: grade IV astrocytomas (5 to 20%), grade III astrocytomas (8 to 18%). These marking differences reflect the heterogeneous nature of the proliferative activity of morphologically similar gliomas. The nuclear marking index with antibody Ki 67 complements the findings of the standard histological examination of cerebral gliomas. This is an additional diagnostic mean to evaluate the proliferative potential and the prognosis of these tumors.

Antibodies, Monoclonal↗
PubMed1989

Discectomies of the lower cervical spine using interbody biopolymer (B.O.P.) implants. Advantages in the treatment of complicated cervical arthrosis. A review of 150 cases.

The authors report their experience with 150 cases of discectomies performed with interbody grafts using a copolymer (Biocompatible Orthopedic Polymer or BOP). Made of N-Vinylpyrrolidone-Methylmethacrylate monomers, polyamide fibres and calcium gluconate. BOP is a biocompatible, biodegradable, osteoconductive matrix, easy to use and quite safe. These properties are quite well appreciated for cervical interbody grafting. After discectomy, stabilization of the spine is immediate, and fusion slowly occurs around and through the biopolymer within one year. The biomaterial avoids morbidity inherent in the harvesting of an autograft, as well as any limitations resulting from the use of allografts.

Adult↗
PubMed1989

[Enlarged transfacial approach in the surgery of tumors of the ethmoid].

Cancers and tumours of the ethmoid bone are characterized by the possibility of extension towards the lamina cribrosa and within the cranium. Removal via a combined neurosurgical and paralateronasal route would appear to provide a more favourable prognosis for the patient. It is, however, a particularly cumbersome approach, and the neurosurgical follow up may be difficult. This is why we recommend a direct approach to both the ethmoid bone and the anterior part of the base of the cranium via a transfacial route, thus permitting complete removal of the tumour and of any intracranial extension through the lamina cribrosa. A number of points of technique are important: the line of the skin incision and the flap of cranial periosteum, operative examination and exploration of the upper part of the tumour, the reconstruction of the meningeal barrier and, if necessary the base of the cranium. The price to be paid for this approach route is the scar which is, however, always of minimum size and well tolerated by patients. Operative follow up is simple--which is the major advantage of the technique--and the carcinological prognosis appears to be as satisfactory as for the combined route.

Ethmoid Sinus↗
PubMed1989

[Should a cancer of the bronchi be surgically treated after excision of a cerebral metastasis?].

Between 1964 and 1987 35 patients were operated on for cerebral metastases due to an underlying bronchial carcinoma. In 26 cases (group 1) there was excision of the primary tumour also and in 9 cases combined medical treatment was given with radiotherapy and chemotherapy. The neurological state was improved by the neurosurgical operation in 88% of patients in group 1 and in 66% of patients in group 2. This improvement was maintained in 30% of the patients as long as they survived. 2 patients died following thoracic surgery (7.69%). The median survival was 11 months in group 1 and 9 months in group 2. Three patients in group 1 were living two years after craniotomy whilst. 1 patient in group 2 is still alive four years after the neurosurgical procedure. The heterogeneity of the two groups does not permit a comparative statistical analysis but overall there does not seem to be any difference in duration or quality of life between the two groups. Complementary cerebral radiotherapy did not affect the prognosis.

Adult↗